Improving Stroke Outcomes in Rural Areas Through Telestroke Programs: An Examination of Barriers, Facilitators, and State Policies

Abstract

This review presents evidence of the value and effectiveness of telestroke programs, as well as an explanation of common barriers and facilitators of telestroke, including licensing and credentialing rules, reimbursement issues, and liability concerns. Most states have adopted policies that affect the adoption of telestroke programs. Georgia and South Carolina are examples of states implementing stroke policies using a telestroke model to treat stroke patients in rural areas.

Telestroke—the promise and the challenge. Part two—expansion and horizons

“…While licensing requirements can vary from state to state, they are largely similar 6. In spite of this near uniformity in licensing requirements, there is enormous state to state variability in telestroke specific licensing 7. For instance, Louisiana and Minnesota are two of nine total states that permit clinicians with an out of state license to practice telemedicine within their state 8 9.…”

“…For instance, Louisiana and Minnesota are two of nine total states that permit clinicians with an out of state license to practice telemedicine within their state 8 9. Conversely, eight states specifically require telemedicine physicians to obtain an in-state medical license 7. Six states do not address telemedicine at all, while most other states have acknowledged telemedicine but made few provisions for its practice 7.…”

“…Conversely, eight states specifically require telemedicine physicians to obtain an in-state medical license 7. Six states do not address telemedicine at all, while most other states have acknowledged telemedicine but made few provisions for its practice 7. Ultimately, the administrative burden of securing multiple state licenses per provider was recently cited as one of the biggest barriers to expanding a telestroke network 4.…”

“…In 2011, Centers for Medicare and Medicaid Services (CMS) attempted to streamline credentialing by allowing credentialing by proxy compacts between referring hospitals and teleconsultants in a telemedicine network 16. In 2012, California was the first state to pass a law addressing hospital credentialing by proxy for physicians in a telestroke network, permitting local hospitals to credential remote physicians by proxy if they met practice requirements in their home facility 7 17 18. Nonetheless, the overwhelming majority of state laws make no provisions for reciprocal credentialing in a telestroke network 7…”

Cost-saving innovations for acute ischemic stroke and transient ischemic attack

“…9 Still, cost-sharing measures or support from the state and federal level are necessary to make telemedicine networks economically feasible, as current reimbursement for telemedicine is limited by law to certain specialties and low-access communities. 10 Fee-for-service reimbursement traditionally requires in-person encounters, which teleneurology is not. The American Academy of Neurology supports the reimbursement of telemedicine encounters in the same fashion as face-to-face, telephonic, and e-mail clinical encounters.…”